Modeling opioid overdose events recurrence with a covariate-adjusted triggering point process

Substance use disorder, particularly opioid-related, is a serious public health challenge in the U.S. Accurately predicting opioid overdose events and stratifying the risk of having such an event are critical for healthcare providers to deliver effective interventions in patients with opioid overdose. Despite a large body of literature investigating various risk factors for the prediction, the existing research to date has not explicitly investigated and quantitatively modeled how an individual's past opioid overdose events affect future occurrences. In this paper, we proposed a covariate-adjusted triggering point process to simultaneously model the effect of various risk factors on opioid overdose events and the triggering mechanism among opioid overdose events. The prediction performance was assessed by the U.S. state-wise Medicaid reimbursement claims data. Compared with commonly used prediction models, the proposed model achieved the lowest Mean Absolute Errors and Mean Absolute Percentage Errors on 30-, 60-, 90, 120-, 150-, and 180-day-ahead predictions. In addition, our results showed the statistical significance of considering the triggering mechanism for recurrent opioid overdose events prediction. On average, around 47% of the event recurrence were explained by the triggering mechanism.